Giant seminoma presenting as a long standing hydrocele: a diagnostic challenge

Seminoma usually presents as a painless solid testicular mass, but associated hydrocele may obscure the diagnosis and delay treatment. We report a 43-year-old man with progressive left scrotal swelling for 1 year and dull aching pain for 3 months. Clinical examination suggested hydrocele because the swelling was soft and transilluminant. Scrotal ultrasonography showed a bulky left testis with a solid component, raising suspicion for neoplasm. Contrast enhanced computed tomography demonstrated a heterogeneously enhancing enlarged left testis measuring 13 × 10.5 × 15 cm with moderate hydrocele. Serum beta human chorionic gonadotropin was elevated, whereas alpha fetoprotein and lactate dehydrogenase were within normal limits. The patient underwent high inguinal orchidectomy. Histopathology confirmed classical seminoma, staged as pT1b. This case highlights that long standing hydrocele with atypical features may conceal testicular malignancy, and early ultrasonography with tumor marker assessment is essential for timely diagnosis.